Renal replacement lipomatosis of the kidney is characterized by renal sinus and perirenal fat proliferation. It is associated with chronic infection and calculi, commonly central, often obstructing. The kidney may be large or small but is usually nonfunctioning. Most of the renal parenchyma has been replaced by fat, pararenal fascia are thickened, and there may be fistulae. We reported radiological findings of renal replacement lipomatosis in a 55 year-old man.